BILL NUMBER: AB 499	CHAPTERED  09/20/00

	CHAPTER   557
	FILED WITH SECRETARY OF STATE   SEPTEMBER 20, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 18, 2000
	PASSED THE SENATE   AUGUST 31, 2000
	PASSED THE ASSEMBLY   AUGUST 31, 2000
	AMENDED IN SENATE   AUGUST 28, 2000
	AMENDED IN ASSEMBLY   JANUARY 20, 2000
	AMENDED IN ASSEMBLY   APRIL 6, 1999

INTRODUCED BY   Assembly Member Aroner
   (Coauthors:  Assembly Members Aanestad, Bates, Corbett, Kuehl,
Steinberg, Strickland, Thomson, Vincent, Wayne, and Zettel)

                        FEBRUARY 18, 1999

   An act to add Section 14132.26 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 499, Aroner.  Medi-Cal:  assisted living demonstration project.

   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services.
   This bill would require the department to develop a federal waiver
program to test the efficacy of providing an assisted living
benefit, as described, to beneficiaries under the Medi-Cal program.
The program would involve reimbursement for services provided to
Medi-Cal recipients placed in residential care facilities.  It would
impose various duties upon both the department and the State
Department of Social Services in implementing the bill.
   The bill would impose certain conditions upon implementation of
the waiver program, and would require an evaluation of that program.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  (a) It is the intent of the Legislature to develop
options that allow elderly and disabled individuals maximum choice in
determining their living arrangements, including the choice to
remain in the least restrictive and most homelike environment as they
age or grow frail.
   (b) It is further the intent of the Legislature to ensure that
elderly and disabled individuals have access to appropriate health
care and personal assistance, regardless of their income level,
health status, or choice of housing arrangement.
  SEC. 2.  Section 14132.26 is added to the Welfare and Institutions
Code, to read:
   14132.26.  (a) The department shall develop a program that
requires a waiver of federal law to test the efficacy of providing an
assisted living benefit to beneficiaries under the Medi-Cal program.
  Assisted living benefits shall include, but are not limited to, the
care and supervision activities specified in Section 1569.2 of the
Health and Safety Code and Section 87101 of Title 22 of the
California Code of Regulations, and other health-related services.
The program developed pursuant to this section shall be known as the
waiver program for purposes of this section.  The department shall
submit any necessary waiver applications or modifications to the
medicaid state plan to the Health Care Financing Administration to
implement the waiver program, and shall implement the waiver program
only to the extent federal financial participation is available.
   (b) The department shall develop the waiver program in conjunction
with other state departments, consumers, consumer advocates, housing
and service providers, and experts in the fields of gerontology,
geriatric health, nursing services, and independent living.
   (c) The assisted living benefit shall be designed to provide
eligible individuals with a range of services that enable them to
remain in the least restrictive and most homelike environment while
receiving the medical and personal care necessary to protect their
health and well-being.  Benefits provided pursuant to this waiver
program shall include only those not otherwise available under the
state plan, and may include, but are not limited to, medicine
management, coordination with a primary health care provider, and
case management.
   (d) (1) Eligible individuals shall be those who are eligible for
the Medi-Cal program and are determined by the department to be
eligible for placement in a nursing facility, as defined under
subdivisions (c) and (d) of Section 1250 of the Health and Safety
Code.  Eligibility shall be based on an assessment of an individual's
ability to perform functional and instrumental activities of daily
living, as well as the individual's medical diagnosis and prognosis,
and other criteria, including other Medi-Cal services that the
beneficiary is receiving, as specified in the waiver.
   (2) An eligible individual shall participate in the waiver program
only if he or she is fully informed of the program and the nature of
the assisted living benefit and indicates in writing his or her
choice to participate.
   (e) (1) The waiver program shall test the effectiveness of
providing a Medi-Cal assisted living benefit through two service
delivery approaches, as specified in paragraphs (2) and (3).
   (2) Under the first model, an assisted living benefit shall be
provided to residents of licensed residential care facilities.
Facility participation in the program shall be determined by the
department in conjunction with the State Department of Social
Services and in accordance with the criteria for participation
specified in the waiver.  Under this model the facility operator
shall be responsible for the provision of services allowed under the
benefit, either directly or through contracts with other provider
agencies, as permitted and specified in the waiver.  During
participation in the waiver program, residential care facilities
shall comply with all terms and conditions of the waiver.  The
department and the State Department of Social Services, may, as
determined necessary and appropriate, waive provisions contained in
Division 2 (commencing with Section 1200) of the Health and Safety
Code, subdivision (h) of Section 14132.95, and Title 22 of the
California Code of Regulations for facilities providing services to
waiver program participants.
   (3) Under the second model, an assisted living benefit shall be
provided to residents in publicly funded senior and disabled housing
projects.  Under this model an independent agency, pursuant to a
contract with the department, shall be responsible for the provision
of case management and other services to eligible individuals, as
specified in the waiver.
   (f) The department shall evaluate the effectiveness of the waiver
program.
   (1) The evaluation shall include, but not be limited to,
participant satisfaction , health, and safety, the quality of life of
the participant receiving the assisted living benefit, and
demonstration of the cost neutrality of the waiver program as
specified in federal guidelines.
   (2) The evaluation shall estimate the projected savings, if any,
in the budgets of state and local governments if the program was
expanded statewide.
   (3) The evaluation shall be submitted to the appropriate policy
and fiscal committees of the Legislature on or before January 1,
2003.
   (g) The department shall limit the number of participants in the
waiver program during the initial three years of its operation to a
number that will be statistically significant for purposes of the
program evaluation and that meets any requirements of the federal
Health Care Financing Administration, including a request to waive
statewide implementation requirements for the waiver program during
the initial years of evaluation.
   (h) In implementing this section, the department may enter into
contracts for the provision of essential administrative and other
services.  Contracts entered into under this section may be on a
noncompetitive bid basis, and shall be exempt from the requirements
of Chapter 2 (commencing with Section 10290) of Part 2 of Division 2
of the Public Contract Code.
   (i) The department shall not implement the waiver program
specified in subdivision (a) if it will result in additional costs to
the state.
   (j) The waiver program shall be developed and implemented only to
the extent that funds are appropriated for that purpose.
